Claim must be assigned and must be filed by the practitioner's employer.
Code type
RARC (Remark)
Category
Medical Necessity
Common CARC pairings
RARC M40 appears with a Claim Adjustment Reason Code (CARC) on the 835 electronic remittance advice and gives more detail about the adjustment. These are the CARCs most often paired with RARC M40.
| CARC | Meaning |
|---|---|
| 272 | Coverage/program guidelines were not met. |
See the full resolution workflow for RARC M40
Members of the EDI-Code Intelligence Lab get the step-by-step rework path, appeal language, root-cause drivers, and prevention checklist for every RARC and CARC pairing, plus payer-specific requirements.
Open in EDI Lab